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Why Fentanyl Is Killing So Many Mainers

Fentanyl crystals and pills

Fentanyl was basically nonexistent on Maine streets two years ago, and now it’s killing more people than heroin, according to police and policy experts.

The drug entered Maine’s opioid crisis with such ferocity because of its unpredictably high potency, authorities say. The synthetic opioid is 100 times stronger than heroin, and 3 milligrams can kill an average-sized adult male. It’s cheaper to make than heroin, making it a popular choice for drug traffickers as they seek to make a bigger profit off of the country’s addiction population.

All of this has resulted in the drug’s soaring presence in Maine, and a rising wave of accidental fatal overdoses.

“At the street level two years ago, it was nonexistent,” said Roy McKinney, the director of the Maine Drug Enforcement Agency. “Now it’s changed, so that we make the presumption that any drug we see, whether is be in pill form or powder form, it may contain fentanyl.”

Last year, fentanyl killed 247 Mainers — more than those who fatally overdosed on heroin, according to the attorney general’s office. On Friday, the AG’s office released a new report that showed the trend continued through the first three months of 2018: Fentanyl again claimed an even larger percentage of lives between January and March, even if the number of overdose deaths dropped slightly compared to the same period last year.

Credit DEA
Photo illustration of 2 milligrams of fentanyl, a lethal dose in most people

Since 2016, police say they have seen fentanyl creep into the market of illicit drugs by showing up in trace amounts in heroin, but also cocaine and even pills. Fentanyl is also often sold as heroin or in place of heroin, often without a drug user’s knowledge, McKinney said.

Fentanyl is often the fatal factor when ingested in combination with other drugs. A 2016 “hotspot study” of overdose deaths in New Hampshire — co-authored by Marcella Sorg of the Margaret Chase Smith Policy Center, who serves as Maine’s forensic anthropologist who counts and analyzes the state’s overdose deaths for the attorney general’s office — found that most people died with multiple drugs in their system. That trend is similar to what occurs in Maine.

But despite that, the New Hampshire study found that “the effects of fentanyl were evidently so strong that there were no statistical differences in the fentanyl level… with or without the presence of these co-intoxicants…. This suggests that fentanyl presence alone seems to be sufficient to cause death.”

One reason fentanyl kills so many people is because of how drug traffickers make it, said Michael Wardrop, a Portland-based DEA agent. The non-pharmaceutical version is manufactured and then packaged for retail distribution in a crude process that increases the chance for accidental overdoses, he said.

Most — if not all — of the illegal fentanyl in the United States comes from China. Mexican drug cartels purchase it there, and then distribute it through the same well-established channels they have used to distribute a variety of drugs through the U.S. for decades, Wardrop said.

But recently, police and the U.S. Department of Justice has cracked down on Chinese fentanyl distributors — resulting in two major indictments last fall, Wardrop said — and drug cartels have stopping buying it, he said. Instead, they are buying the precursor chemicals to make fentanyl from sources in China and manufacturing the drug themselves, he said.

That process lacks quality control, Wardrop said. Fentanyl is so potent that the drug on the street is sold at about a 1 percent purity, but cartels don’t always hit that mark, he said.

The manufacturing process involves mixing the grain-sized fentanyl with a powder cutting agent — usually acetaminophen. That mixture is then sent through a vice that squeezes and compresses it into a 10 gram chunk in the shape of a finger, Wardrop said. Fingers are then distributed to suppliers to be sold to local dealers, he said.

But the fentanyl grains don’t always mix evenly with the cutting agents, meaning some fingers have higher purity levels than others, he explained.

“Picture trying to mix flour and salt. So you take 10 grams of salt, and 150 grams of the powder, you put it in a coffee grinder. How are those grains going to be distributed?” Wardrop said, indicating that it wouldn’t be very evenly.

And so when someone finally buys the drug and uses it, it may be a lethal dose, he said. “It’s like playing Russian roulette.”

The nature of addiction is such that some drug users are willing to take that gamble.

“People already know that most of the drugs contain fentanyl and people are dying,” said Dr. Mark Publicker, a Portland-based addiction specialist. But that hasn’t stopped all people from using opiates, even if they’re getting more dangerous, he said. “That’s the nature of drug addiction.”

It’s unclear how much of Maine’s market is dominated by fentanyl, police said. MDEA wasn’t sure exactly how much fentanyl has been confiscated as it is often laced into other substances and not tested, McKinney said.

And while more people are dying of fentanyl overdoses, “the deaths aren’t going to show [that there’s] more fentanyl than heroin [in Maine] because fentanyl is more toxic,” according to Sorg.

Most traffickers doing business in Maine smuggle in a variety of drugs from places like New York, Connecticut, and Massachusetts, McKinney said.

But Wardrop warned that the market in Northern New England is shifting heavily toward fentanyl.

“I think the dialogue should be changed to allow people to know that more than 90 percent of what’s being distributed in Northern New England, particularly Maine, is fentanyl,” based on his knowledge of DEA investigations in the region, he said.

He said he only expects the amount of fentanyl being sold and ingested here to keep rising.

This story appears through a media sharing agreement with Bangor Daily News.